Joseph Josmi, Singhal Shashideep, Patel Gia M, Anand Sury
Department of Gastroenterology, The Brooklyn Hospital Center, New York Presbyterian Healthcare System, Brooklyn, NY.
Am J Ther. 2014 Sep-Oct;21(5):385-94. doi: 10.1097/MJT.0b013e318245992d.
Clostridium difficile infection (CDI) is the leading cause of antibiotic-associated and nosocomial infectious diarrhea. Presenting as clostridium difficile colitis, it is a significant cause of morbidity and mortality. Metronidazole is regarded as the agent of choice for CDl therapy and also for the first recurrence in most patients with mild to moderate CDI. Vancomycin is recommended as an initial therapy for patients with severe CDI. With recent Food and Drug Administration-approval fidaxomicin is available for clinical use and is as effective as vancomycin with lower relapse rates. Rifaximin and fecal bacteriotherapy are alternative approaches in patients with severe or refractory CDI, before surgical intervention. Antibiotic research is ongoing to add potential new drugs such as teicoplanin, ramoplanin, fusidic acid, nitazoxanide, rifampin, bacitracin to our armamentarium. Role of toxin-binding agents is still questionable. Monoclonal antibody and intravenous immunoglobulin are still investigational therapies that could be promising options. The ongoing challenges in the treatment of CDI include management of recurrence and presence of resistance strains such as NAP1/BI/027, but early recognition of surgical candidates can potentially decrease mortality in CDI.
艰难梭菌感染（CDI）是抗生素相关性及医院感染性腹泻的主要病因。其表现为艰难梭菌性结肠炎，是发病和死亡的重要原因。甲硝唑被视为CDI治疗以及大多数轻至中度CDI患者首次复发时的首选药物。万古霉素被推荐作为重症CDI患者的初始治疗药物。随着美国食品药品监督管理局（FDA）最近批准非达霉素可用于临床，其疗效与万古霉素相当，但复发率更低。在手术干预前，利福昔明和粪便细菌疗法是重症或难治性CDI患者的替代治疗方法。抗生素研究正在进行，以将诸如替考拉宁、雷莫拉宁、夫西地酸、硝唑尼特、利福平、杆菌肽等潜在新药纳入我们的治疗手段。毒素结合剂的作用仍存在疑问。单克隆抗体和静脉注射免疫球蛋白仍是具有前景的研究性治疗方法。CDI治疗中当前面临的挑战包括复发病例的管理以及诸如NAP1/BI/027等耐药菌株的存在，但早期识别手术候选患者有可能降低CDI的死亡率。
